耐亚胺培南铜绿假单胞菌的耐药机制及亲缘性研究

目的 探讨广东省中医院4所分院临床分离的72株耐亚胺培南铜绿假单胞菌的多药耐药性、主要耐药机制和亲缘性.方法 采用聚合酶链反应检测Ⅰ类整合子遗传标记intⅠ1,外膜通道蛋白基因oprD2,β-内酰胺酶GES、KPC、IMP-1、IMP-9 、VIM-1 、VIM-2、SIM、SPM、GIM、AIM、NDM、KHM、DHA、PDC、OXA-40、OXA-23等18种基因,并对所获得的结果进行多基因聚类分析.结果 72株铜绿假单胞菌中IMP-9、PDC、oprD2、intⅠ1基因阳性率较高,分别为70.8％、98.6％、86.1％、100.0％,KPC、IMP-1、VIM-2、DHA基因阳性率较低,分别为2.8％、9.7％、13.9％、18.1％,GES、VIM-1、SIM、SPM、GIM、AIM、NDM、KHM、OXA- 40、OXA- 23基因均为阴性；72株铜绿假单胞菌有52株产金属酶；多基因聚类分析结果显示,72株铜绿假单胞菌可分3群,每群均存在克隆传播.结论 产生金属酶是72株铜绿假单胞菌对亚胺培南耐药的最主要原因；多基因聚类分析法对临床治疗和医院感染的预防控制具有指导意义.

Drug resistance mechanisms and affinity of imipenem-resistant Pseudomonas aeruginosa

OBJECTIVE To explore the multiple drug resistance,resistance mechanisms and affinity of 72 strains of imipenem-resistant Pseudomonas aeruginosa(PAE) isolated from four branches of Traditional Chinese Hospital of Guangdong province.METHODS Polymerase chain reaction(PCR) was adopted for detection of 18 resistance genes intⅠ1,oprD2,GES,KPC,IMP-1,IMP-9,VIM-1,VIM-2,SIM,SPM,GIM,AIM,NDM,KHM,DHA,PDC,OXA-40 and OXA-23;multiple gene cluster analysis of the acquired results was performed.RESULTS Of 72 strains of PAE,the positive rates of IMP-9,PDC,oprD2,and intⅠ1 were relatively high,which were 70.8%,98.6%,86.1%,and 100.0%,respectively;the positive rates of KPC,IMP-1,VIM-2,and DHA were relatively low,which were 2.8%,9.7%,13.9%,and 18.1%,respectively;GES,VIM-1,SIM,SPM,GIM,AIM,NDM,KHM and OXA-40 were all negative;of these 72 PAE isolates,52 isolates produced metallo-β-lactamases;the result of DRGT showed that 72 isolates could be divided into three groups,and there was clonal dissemination in every group.CONCLUSION Imipenem resistance of these 72 isolates of PAE is most closely related to the production of metallo-β-lactamase.DRGT has significance in guiding the clinical treatment and prevention and control of nosocomial infections.